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It Is Complex: Predicting Gastroschisis Outcomes Using Prenatal Imaging.

Sarah G Fisher¹, Cassandra M Anderson¹, Nicole P Steinhardt²

¹Section of Pediatric Surgery, Riley Hospital for Children, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

The Journal of Surgical Research

|October 14, 2020

Summary

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This summary is machine-generated.

Prenatal ultrasound can predict complex gastroschisis, a condition requiring longer feeding times and hospital stays. Absence of specific ultrasound markers suggests uncomplicated gastroschisis, aiding in early outcome prediction.

Area of Science:

Pediatric Surgery
Fetal Medicine
Neonatology

Background:

Gastroschisis affects 1 in 2000 births, with outcomes influenced by intestinal complications and feeding timelines.
Prenatal imaging advancements offer improved insight into postnatal outcomes for gastroschisis.
Survival rates are linked to managing intestinal issues and the time to initiate feeding.

Purpose of the Study:

To analyze gastroschisis patient data from a single children's hospital in the modern era.
To utilize prenatal ultrasound (US) findings to develop novel prognostic indicators for gastroschisis.
To identify prenatal US markers that predict the severity of gastroschisis at birth.

Main Methods:

Retrospective review of 134 gastroschisis patients (2010-2018) at a quaternary-care children's hospital.

Keywords:

Complex Gastroschisis Prenatal imaging Prognostic factors Ultrasound

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Evaluation of second and third-trimester prenatal US for amniotic fluid levels, external bowel characteristics, and bowel wall edema.

Comparison of complex gastroschisis (atresia/perforation) with uncomplicated cases using statistical analyses (chi-square, univariate, multivariable).

Main Results:

Complex gastroschisis patients required significantly longer median days for feeding initiation (44 vs. 10 days) and full feeding (80 vs. 23 days).
Third-trimester prenatal US showed polyhydramnios in 23.5% of complex cases versus 4.3% of uncomplicated cases (P=0.018).
Key US predictors for complex gastroschisis included significant polyhydramnios, increased external bowel, bowel edema, and bowel dilation on third-trimester scans.

Conclusions:

Polyhydramnios on third-trimester prenatal ultrasound is a significant predictor of complex gastroschisis.
Absence of specific prenatal US markers suggests uncomplicated gastroschisis, aiding in outcome prediction.
Complex gastroschisis is associated with prolonged time to feeds and extended hospital stays.